TB down in past decade; universal health coverage key to faster progress

Media release

New estimates show a 14% reduction in the incidence of tuberculosis (TB) in the World Health Organization (WHO) Western Pacific Region over the past decade. However, there remain 1.8 million people newly infected in the Region each year and more needs to be done to combat the spread of this disease. On World Tuberculosis Day, WHO calls on governments to provide all citizens’ access to TB testing and treatment as part of universal health coverage.

“The TB rate is coming down in the Region, but it’s not happening fast enough. We need to do much more to achieve our goal of ending the epidemic once and for all.”

Dr Shin Young-soo, WHO Regional Director for the Western Pacific.

The Region has seen progress, with TB treatment coverage increasing from 69% in 2007 to 76% in 2016. The TB mortality rate in the Region (5 per 100 000 population in 2016) remains much lower than the global average (17 per 100 000). More than 90% of new cases in the Region are treated successfully, but drug-resistant forms of the disease remain a concern.

TB is still a high burden infectious disease in Viet Nam. According to the Global TB report 2017, Viet Nam was ranked 16th among 30 of the world’s highest burden countries for TB. There are an estimated 130,000 new cases, and about 14,000 deaths due to TB occur every year in Viet Nam. However there has been much progress over recent years. During the period 1990 – 2013 mortality and prevalence decreased by 4.6% and 4.4% every year, respectively. In addition about 80 % of the estimated cases are being diagnosed and enrolled on treatment, of which 91% are treated successfully.

The theme of World TB Day 2018 - “Wanted: Leaders for a TB-free world”

WHO’s End TB Strategy calls on countries to reduce TB deaths by 95% and cut new cases by 90% between 2015 and 2035. To reach the strategy’s 2020 interim target, the speed of reducing TB incidence in the Western Pacific Region must accelerate to 4–5% per year from the current 2%.

Viet Nam is still facing challenges to achieve the goal of end TB by 2030. Although the TB rate is decreasing yearly, the rate of decline remains slow. Approximately 20% of people infected with TB have not been diagnosed and treated. The utilization of innovative tools to diagnose multi-drug TB resistance is not yet utilized at the district level. Ensuring the financial resource to continue providing TB care free-of-charge to uninsured TB patients is still a challenge.

Lastly, one in four people with TB are not getting treatment through public health programmes. Action is needed to understand whether they are getting effective treatment in the private system or not at all.

What is TB?

TB is one of the top 10 causes of death in the world. When someone with lung TB coughs, sneezes, or spits, they can spread the infection. TB germs can remain in the air for up to six hours, making people in overcrowded areas especially susceptible.

Symptoms include persistent cough, bloody sputum, fever, chills and weight loss. The disease can be especially devastating for people with other health issues, which weaken their immune system, such as HIV and diabetes. The risk of TB also increases for people who are undernourished, smoke tobacco, drink alcohol or are exposed to air pollution.

Initially some people may experience only mild symptoms and may not realize they are infected. Others may not have access to treatment, either because of unavailability of service or cost. A person with untreated TB can infect up to 15 others a year.

“While TB is highly contagious, it is also entirely preventable and curable,” says Dr Shin. “That is what makes its impact so tragic.”

A disease of poverty

More tragic is the fact that TB often strikes those who can least afford it. More than 95% of TB cases and deaths in the world are in developing countries, with 45% of new cases in Asia, according to 2016 figures.

In parts of the Western Pacific Region, up to 60% of TB patients and their families face catastrophic costs—that is, more than 25% of household income goes on treatment. The financial burden includes not only costs such as hospitalization and medicine, but also non-medical costs such as transportation, lodging and loss of income while receiving care. According to the End TB Strategy targets, by 2020, no family should face catastrophic costs due to TB.

WHO calls on governments to accelerate progress towards universal health coverage so that all people have access to good quality health services, where and when they need them and without financial hardship. Reducing costs and other barriers makes those infected with TB more likely to seek treatment early. As a result, they will recover faster, diminishing the chances of spreading the disease, and be able to resume healthy, productive lives.

“Universal health coverage can contribute to a substantial reduction in TB rates, while helping families avoid spiralling into poverty. Governments are beginning to realize that investing in universal health coverage actually saves money in the long run,” explains Dr Shin.

In addition to improving coverage of existing services, including faster scale-up of new technologies, putting an end to TB in the Region requires innovations in diagnostics, treatments, vaccines and service delivery.

WHO is calling on countries to address all the determinants of TB through high-level commitments and approaches that involve sectors outside of health, such as education and housing. Dr Shin stresses that countries must stay the course: “By taking these steps, we inch ever closer to achieving our vision of zero deaths, zero disease and zero suffering due to TB.”

WHO in Viet Nam is working together with the National TB program and partners to address tuberculosis. Currently, our support focuses on development of tuberculosis policy, building capacity for health workers working for TB, research in applying new technologies for diagnostics, tool and drugs for TB treatment, and monitoring and evaluating the progress of the TB programme in country.